Written By: Justin Sanchez, PTA, Teton Therapy Cheyenne
It took a few weeks to become manageable, and it seemed to go away after about a month. Then it started again – your chronic back pain.
When Pain Doesn’t Go Away
This time it didn’t really go away. You tried resting your back and using the same methods as before (Ibuprophen, Advil, Icy hot), which helped a little but never fully worked. Months passed with the same pain, and you grew more cautious – avoiding long walks and anything heavy. Bending too far can now set you back for a day or two. One day you pushed it by mowing both the front and back yard because it felt okay. That was a mistake. Afterward, your back went into nonstop spasms, and you missed a full week of work.
You went back the following week – not because the pain improved, but because you were running out of time off and bills didn’t stop. You made it through the day, then the week, then the month, but at a cost. By the time you get home, you’re exhausted, with nothing left for chores or family. You try to muster energy for what matters most, but you’ve already given more than you had just to function at work. At first your family understands, but after months, that compassion fades – replaced by frustration, a nod, maybe a silent eye roll. You stop bringing it up. Life has become immensely stressful, all because of your ongoing back pain.
From Acute Injury to Chronic Pain
This is an unfortunately common example of how an acute injury spirals into a significant and chronic issue. Chronic low back pain (CLBP) is a pervasive public health crisis in the United States, standing out as one of the primary, and most financially burdensome, causes of long-term disability. Its impact reaches far beyond individual suffering, affecting workforce productivity and healthcare systems. Acute low back pain is extremely common. It is recognized as one of the most frequent medical complaints encountered by healthcare professionals across all settings, second only in commonality to the common cold. This places low back pain – in both its acute and chronic forms – at the epicenter of daily clinical practice and patient discomfort.
Treating chronic back pain in physical therapy can seem daunting for both the patient and practitioner, but I’ve found a few strategies and principles that have paved the way to success in managing these conditions.
Separate the Injury from the Pain
It’s important to dissociate the initial injury from the current pain.
More important than what happened initially, is what the current deficits are. If an injury occurred 20 years ago, the body has had ample time to undergo a healing process. Pain can persist in areas despite normal tissue healing and the absence of any pathology. Commonly, dysfunctional movement patterns develop not only around the area that was injured; but also in the surrounding joints and muscles. Dysfunctional movement patterns have the tendency to contribute to ongoing pain in an area.
Graded Exposure and Function
Recognize in what ways your current condition affects your livelihood and ability to be an active participant in your life. Then use the graded exposure approach.
Many people become more and more limited in what they are able to do, or are confident doing, the longer pain persists. Hobbies become sparse, and I’ve found that many people stop enjoying life. This is important because this contributes to the suffering aspect of chronic pain. Depressive cycles from suffering can add fuel to the pain experience, and will intensify pain. When being treated in physical therapy, it is good to identify what you would like to be able to do if all pain were gone. I will typically encourage people to begin these activities early in the course of treatment, but in low doses at first. As pain and tolerance to movement improves, the more I encourage people to do.
Address Movement Dysfunction
Now we can look at addressing movement dysfunction. I start with a general movement screen consisting of bending forward, backward, side to side, and rotating. If there is a specific movement, action, or posture that immediately reproduces pain, this is also investigated.
Once we find some movement limitation that produces pain I will usually start with a hands-on technique that addresses that issue. There are different techniques such as joint mobilization, myofascial mobilization, nerve mobilization etc. that aim to address different movement limitations. I will then re-test the same aggravating movement or position to determine the effectiveness of the intervention that I performed. If the pain with the associated movement persists, I may trial additional techniques until the limitation is resolved.
After mobility is addressed, I love to address the pattern of movement that was previously painful. Often, long term pain disrupts normal movement patterns such as walking, bending forward, or even breathing! I will help to identify compensated or abnormal movement patterns to help maintain the benefits gained from hands-on therapy techniques.
The process of addressing painful movements, mobility, and pattern re-education may take a few or several visits to improve movement tolerance adequately to then start strengthening and exercise. For low back pain there are a few key exercises that I like to have people incorporate into their exercise program; squats, deadlifts, bridges, pallof press, and side steps with a band around the ankles. Often I will incorporate some creative exercises that address more specific needs for patients, but the aforementioned do encompass a wide range of muscles that are frequently weak with persistent low back pain. I will typically have the person aim for ½ day of mild to moderate muscle soreness following an exercise session. If it lasts longer than that or is more severe, the exercise intensity is reduced. If there is no muscle soreness, we can increase exercise intensity.
Recovery and Outlook
Chronic low back pain can be an enormous struggle. Physical therapy can be a tremendous help in reducing pain with movement and restoring normal movement patterns to get you back to doing what you want to do and truly enjoy your life again.
Take the First Step
The therapists at Teton Therapy are experts in back injuries and can help you break the cycle of chronic stress and injury.
Call, text or click to schedule your back pain consultation today!
In Cheyenne, 307-514-9999,
In Lander, 307-332-2230,
In Riverton, 307-857-7074
or find us on the web at TetonTherapypc.com
